Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis.

OBJECTIVE: Rheumatoid arthritis (RA) fatigue is not being well-managed currently, and evidence of effective interventions is limited. Aerobic exercise may provide benefit to treat fatigue in RA. Therefore, the purpose of this meta-analysis is to analyze the effect of aerobic land-based exercise on fatigue in RA. METHODS: A literature search was conducted using PubMed, Cochrane Library, Embase, and trial registers to identify randomized controlled trials (RCTs) with a supervised land-based aerobic exercise program performed with an intensity between 50% and 90% of maximal heart rate, of at least 15 minutes' duration, performed at least 2 times a week, and lasting for a time period of at least 4 consecutive weeks. Risk of bias was assessed using the Cochrane tool. A meta-analysis of fatigue outcomes was performed by calculating the standardized mean difference (SMD) using a random-effects model. RESULTS: Five RCTs were included. None of the trials selected patients with RA for having fatigue. Risk of bias was low in 3 RCTs and unclear in 2. Land-based aerobic exercise programs had a positive effect on fatigue in RA compared to no exercise at 12 weeks, SMD -0.31 (95% confidence interval [95% CI] -0.55, -0.06). At 24 weeks, the effect of aerobic land-based exercise was smaller and not statistically significant: SMD -0.15 (95% CI -0.33, 0.02). CONCLUSION: There is evidence with low risk of bias that an aerobic exercise program is effective in reducing fatigue among patients with RA, especially in the short term; however, effects are small. To substantiate the evidence, RCTs should be performed in patients with RA selected for having fatigue.

Physical activity research in nursing.

PURPOSE: To present exemplars of physical activity research in nursing, illustrate the importance of physical activity research across the lifespan, and recommend directions for theory development and research. METHODS: Studies of physical activity and exercise currently being conducted by nurse investigators were reported and critiqued by attendees of the Midwest Nursing Research Society 2000 Preconference session entitled "Promoting Physical Activity Among Diverse Groups Across the Health Continuum." Physical activity and exercise literature during the past decade was reviewed. Databases searched included Medline, CINAHL, Wilson, and ERIC. FINDINGS: Investigators have emphasized the need to evaluate the effects of theory-based physical activity interventions designed to alter key correlates of physical activity identified through descriptive research. CONCLUSIONS: Regular physical activity is necessary for health promotion and disease prevention for all populations. Continued research in this important area of health behavior is critical to identify the most effective interventions to increase physical activity among diverse populations.

Use of different absorbable sutures for continuous single-layer anastomosis in the gastrointestinal tract. A prospective, randomized study.

BACKGROUND AND AIMS: A prospective, randomized study was designed to test the safety of the single-layer continuous anastomosis technique in gastrointestinal surgery. Results from the use of two different sutures were compared in relation to postoperative complications. MATERIAL AND METHODS: The safety of a single-layer continuous technique using two different types of absorbable suture was studied in 247 anastomoses performed on 183 patients between 1996 and 1997. There were 26 gastric, 117 small-bowel, 32 colonic, 29 pancreatic and 43 biliary anastomoses in the study. In 134 cases, Poliglecaprone 25 (Monocryl, Johnson & Johnson) was used, and in 113 cases Glycomer 631 (Biosyn, USSC). All procedures were carried out by the same surgeon. RESULTS: Anastomosis-related complications were detected in 7 patients (2.8%). Anastomotic failures including minor leakage occurred in 5 cases (2.0%). Reoperation was required in only 1 patient (0.4%), and there were no deaths. No difference was found in the dehiscence rate between the two types of absorbable material (1.5% with Monocryl and 2.6% with Biosyn; p = 0.5). CONCLUSION: Compared with other techniques used for gastrointestinal anastomosis, this technique is safe and easy to apply using either suture material.

[Inguinal hernia repair with mesh plug technique (initial experiences with a new, tension-free surgical method)]. / Inguinalis sérvek rekonstrukciója mesh plug technikával (kezdeti tapasztalataink egy új, feszülésmentes mútéti eljárással).

Majority of inguinal hernia repair are performed in Hungary by traditional surgical techniques, reconstruction under tension (Bassini, Kirschner, Shouldice). Hernia surgery underwent a revolutionary change from the 80's. Set out from the United States, tension-free methodologies (Lichtenstein, laparoscopy, mesh plug) have spread worldwide, of which early and late results--especially recurrence rate--are significantly better than the formerly used techniques. Authors introduce the surgical technique of mesh plug hernioplasty and their promising experiences after the first 80 operations.

Defining and measuring fatigue.

In response to a long history of problems with defining and measuring fatigue, the University of Kansas School of Nursing established a Center for Biobehavioral Studies of Fatigue Management to facilitate the study of fatigue in diverse populations. The purpose of this article is to review past efforts to define and measure fatigue and the conceptual problems relevant to currently used measures of fatigue. Several distinct characteristics and corresponding measures of fatigue are identified and a definition and framework for the study of fatigue are discussed. Future research on fatigue must attend to the conceptual distinctions among various measures and the measures of fatigue most appropriate to the goals of a study.

[Single layer continuous absorbable sutures for gastrointestinal anastomosis]. / Egyrétegú, tovafutó, felszívódó varratsorral készült anasztomózis a gastrointestinalis sebészetben.

Authors evaluated the safety of single layer continuous sutured anastomosis technique with two different types of absorbable sutures in 252 anastomoses performed on 178 patients. In the prospective, randomized study 5 oesophagus, 26 stomach, 117 small intestine, 32 colonic, 29 pancreatic and 43 biliary anastomoses were performed. In 136 cases poliglecaprone 25 (Monocryl), in 116 cases glycomer 631 (Biosyn) were used. All procedures were carried out by the same surgeon. Anastomosis related complication was detected in 7 cases (2.8%), some kind of anastomosis insufficiency--including minor leakage--in 5 cases (2.0%), but reoperation only in one case (0.4%) was required. There was no anastomosis related death. Authors overview the advantages of the technique, which is safe, cheap, easy to carry out, physiological and least harmful to the blood supply, so they recommend its use in the gastrointestinal surgery as a standard procedure.

Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis.

The effects of 12 weeks of low-impact aerobic exercise on fatigue, aerobic fitness, and disease activity were examined in a quasi-experimental time series study of 25 adults with rheumatoid arthritis (RA). Measures were obtained preintervention, midtreatment (after 6 weeks of exercise), end of treatment (after 12 weeks of exercise), and at a 15-week follow-up. ANOVAS for repeated measures showed that those subjects who participated more frequently reported decreased fatigue, while those who participated less frequently reported an increase in fatigue. All subjects, on average, showed increased aerobic fitness and increased right and left hand grip strength, decreased pain, and decreased walk time. There were no significant increases in joint count or sedimentation rate. Significant improvements in measures at the 15-week follow-up also were found. Findings indicate that persons with RA who participate in appropriate exercises may lessen fatigue levels and experience other positive effects without worsening their arthritis.

Determinants of exercise and aerobic fitness in outpatients with arthritis.

Factors that influenced exercise behaviors and aerobic fitness were identified in 100 outpatients with rheumatoid arthritis or osteoarthritis. Data included perceived health status, benefits of and barriers to exercise, and impact of arthritis on health; demographic and biologic characteristics; and past exercise behavior. Exercise measures included range-of-motion and strengthening exercises, 7-day activity recall, and the exercise subscale of the Health-Promoting Lifestyle Profile. An aerobic fitness level was obtained on each subject by bicycle ergometer testing. The theoretical model predicted 20% of the variance in composite exercise scores but none of the variance in aerobic fitness levels. Perceived benefits of exercise was a significant predictor of exercise participation. Subjects with less formal education, longer duration of arthritis, and higher impact of arthritis scores perceived fewer benefits of exercise, while subjects who reported exercising in their youth perceived more benefits of exercise.

Promoting self-care in clients with arthritis.

Preliminary work regarding the development and pilot study of an individualized instructional program for rheumatoid arthritis clients is presented. The effect of the individualized instructional program was tested with 31 outpatients. Using analysis of covariance, the experimental group subjects scored significantly higher on the knowledge post-test when compared to scores of control group subjects (P = 0.0045). Analysis of variance for repeated measures revealed no significant difference in performance of tasks for the control group and experimental group (P = 0.08). In a follow-up study, the effect of the self-instructional program, practice time, and contracting were explored for their effect on adherence to self-care activities. Experimental groups (n = 42) scored significantly better than the control group (n = 11) on the knowledge post-test (P < 0.01), performance of joint protection practices (P = 0.01), range of motion exercises (P = 0.01), and adherence to joint protection practices at home (P < 0.01). Groups did not differ on adherence to range of motion exercises at home (P = 0.83).

Biosynthesis of riboflavin. Enzymatic formation of 6,7-dimethyl-8-ribityllumazine by heavy riboflavin synthase from Bacillus subtilis.

The beta subunits of heavy riboflavin synthase catalyze the formation of 6,7-dimethyl-8-ribityllumazine from 5-amino-6-ribitylamino-2,4(1H,3H)-pyrimidinedione and a carbohydrate phosphate, Compound X. 5-Amino-6-ribitylamino-2,4(1H,3H)-pyrimidinedione 5'-phosphate is not a substrate for the enzyme, although it is an established intermediate in the biosynthesis of riboflavin. It follows that this pyrimidine phosphate must be dephosphorylated prior to the formation of 6,7-dimethyl-8-ribityllumazine.

Biosynthesis of riboflavin. Enzymatic formation of 6,7-dimethyl-8-ribityllumazine from pentose phosphates.

The xylene ring of riboflavin originates by dismutation of the precursor, 6,7-dimethyl-8-ribityllumazine. The formation of the latter compound requires a 4-carbon unit as the precursor of carbon atoms 6 alpha, 6, 7, and 7 alpha of the pyrazine ring. The formation of riboflavin from GTP and ribose phosphate by cell extract from Candida guilliermondii has been observed by Logvinenko et al. (Logvinenko, E. M., Shavlovsky, G. M., Zakal'sky, A. E., and Zakhodylo, I. V. (1982) Biokhimiya 47, 931-936). We have studied this enzyme reaction in closer detail using carbohydrate phosphates as substrates and synthetic 5-amino-6-ribitylamino-2,4-(1H,3H)-pyrimidinedione or its 5'-phosphate as cosubstrates. Several pentose phosphates and pentulose phosphates can serve as substrate for the formation of riboflavin with similar efficiency. The reaction requires Mg2+. Various samples of ribulose phosphate labeled with 14C or 13C have been prepared and used as enzyme substrates. Radioactivity was efficiently incorporated into riboflavin from [1-14C]ribulose phosphate, [3,5-14C]ribulose phosphate, and [5-14C]ribulose phosphate, but not from [4-14C]ribulose phosphate. Label from [1-13C]ribose 5-phosphate was incorporated into C6 and C8 alpha of riboflavin. [2,3,5-13C]Ribose 5-phosphate yielded riboflavin containing two contiguously labeled segments of three carbon atoms, namely 5a, 9a, 9 and 8, 7, 7 alpha. 5-Amino-6-[1'-14C] ribitylamino-2,4 (1H,3H)-pyrimidinedione transferred radioactivity exclusively to the ribityl side chain of riboflavin in the enzymatic reaction. It follows that the 4-carbon unit used for the biosynthesis of 6,7-dimethyl-8-ribityllumazine consists of the pentose carbon atoms 1, 2, 3, and 5 in agreement with earlier in vivo studies.

Biosynthesis of riboflavin. An aliphatic intermediate in the formation of 6,7-dimethyl-8-ribityllumazine from pentose phosphate.

6,7-Dimethyl-8-ribityllumazine synthase deficient mutants of Candida guilliermondii were divided into two groups on the basis of in vitro complementation. Mutants of complementation group I produce an intermediate X from ribose 5-phosphate in a reaction requiring Mg++ ions. Compound X was partially purified and was shown to be a phosphoric acid ester. 6,7-Dimethyl-8-ribityllumazine can be formed from Compound X by cell extracts from mutants of complementation group II. The reaction requires 5-amino-6-ribitylamino-2,4(1H,3H)-pyrimidinedione or its 5'-phosphate as second substrate. No divalent cations are required.

Biosynthesis of riboflavin. Enzymatic formation of the xylene moiety from [14C]ribulose 5-phosphate.

We have studied the enzymatic formation of the xylene ring of riboflavin using cell extracts from the flavinogenic yeast Candida guilliermondii. 5-Amino-6-ribitylamino-2,4(1H,3H)-pyrimidinedione or its 5'-phosphate could serve as substrates. In addition, a pentose phosphate or pentulose phosphate was required. Experiments with [14C]ribulose 5-phosphate gave evidence for the incorporation of the ribulose carbon atoms except C-4 into the xylene ring of the vitamin.